伊班磷酸钠对老年骨质疏松性骨折愈后影响的临床研究

Clinical research of the effect of ibandronate on the prognosis of osteoporotic fractures in the elderly

目的探讨老年骨质疏松性股骨粗隆间骨折术后应用伊班磷酸钠对骨折愈后的影响,以期对骨质疏松性骨折术后进行科学、合理化治疗。方法选取2011年9月至2013年6月在我院骨科住院手术治疗的老年股骨粗隆间骨折的患者共135例。选取符合股骨颈骨密度(T值<-2.5)的患者120例。将患者随机分成4组,每组30人,行PFNA手术,分别是不用药物组(A组)、术后1周用药组(B组)、1个月(C组)、3个月(D组)行伊班磷酸钠注射液2mg静点,连续两天,每3个月静点1次。随访患者骨折愈合情况,并发症以及骨密度值变化。收集的数据用SPSS 16.0统计软件进行分析,统计学处理数据以均数±标准差(x±s)表示,计数资料比较采用重复测量的方差分析,P<0.05差异有显著性,具有统计学意义。结果 4个组间骨折愈合时间没有统计学意义。共有18位病人因固定失败或死亡而失去随访,组间并发症的发生没有统计学差异。所有患者的Harris髋关节功能评分及并发症在4个组之间比较无统计学差异。B、C、D 3组骨密度较术前明显升高,而A组骨密度较术前降低,二者比较有统计学差异。结论本研究结果表明在老年人股骨粗隆间骨折后,不同时间段应用伊班磷酸钠可提高其骨密度,但对其愈后没有明显不利影响。

Objective To explore the effect of ibandronate on prognosis of osteoporotic intertrochanteric fractures in the elderly.Methods A total of 135 elderly patients who were operated for the intertrochanteric fracture in the department of orthopedics of our hospital from September 2011 to June 2013 were selected. One hundred and twenty patients whose T score of the femoral neck lower than- 2. 5 were selected. These patients were randomly divided to 4 groups： including Group A（ control group）,Group B（ drug applied from one week after surgery）,Group C（ drug applied from one month after surgery）,and Group D（ drug applied from three months after surgery）. All patients received ibandronate 2mg intravenous injection for 2 consecutive days,once every 3months,and continued for one year. Fracture healing,complications,and changes in bone mineral density were followed up. The data were expressed as M± SD（ x± s）. The comparison of enumeration data used repeated measurement variance analysis. P〈0. 05 was considered statistically significant. Results The mean time of fracture healing was not statistically significant among the4 groups. A total of 18 patients were loss of follow-up due to failure of fixation or death. The difference of the complication was not different among the 4 groups. Harris hip score and complication of all patients among the 4 groups were not statistically different.Bone mineral density in group B,C,and D increased significantly compared with that before the operation,but bone mineral density in group A decreased. The difference was statistically significant. Conclusion The research indicates that administration of ibandronate at different time increases bone mineral density in elderly patients with intertrochanteric fractures,with no unfavorable effect to the prognosis.